Standardized Physical Exam Teaching Associate (SPETA)

The Foundations of Doctoring curriculum here uses standardized physical exam teaching associates (SPETA) to teach basic clinical skills to medical students early in their medical education. While the use of SPETAs to teach clinical skills is by no means unique among medical schools, I believe that the extent to which SPETAs and simulated clinical settings are used in this curriculum is remarkable - especially in years 1 and 2.

Traditionally, the first two years of medical school are reserved almost exclusively for lecture-based torture of students. One professor recently recounted how he didn't see his first patient until his third year of medical school, and he wondered aloud to the class how learning about molecules and organ systems could have adequately prepared him for the real doctor-to-patient interaction. That concern was the driving force behind curriculum innovations that led to this Foundations of Doctoring course, which spans the first three years.

This curriculum innovation brings some much-appreciated balance to the life of a first-year medical student. Today, for instance, I spent the entire morning in the dissection lab, then in the afternoon, I learned how to give a musculoskeletal examination. Such juxtaposition of death and life 1) helps to ground me to the larger purpose of this masochistic exercise that we call medical school, to become a doctor with knowledge and compassion enough to effectively treat my patients, and 2) gives me a leg up on the USMLE Step 2 and residency applications, with early development of clinical skills.

I have actually never received a musculoskeletal examination in my adult life, so this was all new to me. It basically involves a head to toe check-up of all muscles, bones, and joints, including: visual observations of skin, posture, and gait; palpating (fancy-schmancy medical terminology for "feel over skin") muscles, bones, and joints; and range of motion tests on all the joints. Together with two of my classmates, the SPETA covered the entire musculoskeltal exam in a two hour session. She first gave an overview of the examination. Taking it in parts, she explained each step in detail then allowed my classmates and me to practice that step on her.

We have one of these sessions about once every week, coordinated with the course material for the Human Body (anatomy) block.